The bill amends Section 514F.8 of the Iowa Code to establish new requirements for utilization review organizations regarding prior authorizations. It mandates that these organizations respond to urgent requests within 48 hours and nonurgent requests within 10 calendar days, extending to 15 calendar days in cases of complexity or high volume. Additionally, organizations must notify health care providers of receipt of prior authorization requests within 24 hours. The bill also requires annual reviews of health care services that require prior authorization, with the aim of eliminating unnecessary requirements that do not enhance health care quality or reduce costs. Complaints about compliance can be directed to the insurance division, which will keep such complaints confidential.

Furthermore, the bill introduces a prior authorization exemption program that health carriers must implement by January 15, 2026. This program will exempt certain health care providers, including primary care providers, from specific prior authorization requirements. Health carriers are required to provide detailed information about the exemption program on their websites, including eligibility criteria and exempt services. By January 15, 2027, carriers must report to the commissioner of insurance on the program's results, including cost analyses, recommendations for future actions, and feedback from providers.

Statutes affected:
Introduced: 514F.8